Q & A

What Notices Must be Provided to Qualified Beneficiaries under COBRA?

Generally, the Consolidated Omnibus Budget and Reconciliation Act (COBRA) requires employers with 20 or more employees that provide group health plan coverage to offer continuation of coverage. The employer must offer the continuation of coverage to qualified beneficiaries (QB) who have lost coverage as a result of certain qualifying events. This includes regulatory requirements to provide notices with mandated content and specific timeframes. Note: Multi-employer plans have special rules for COBRA notice requirements. Failure to administer the notices in compliance with the COBRA regulations can result in adverse consequences for the employer.

 

The four notices the employer is required to provide QBs are as follows:

 

General Notice/Initial Notice

The general notice describes general COBRA rights and employee obligations. This notice must be provided to each covered employee and each covered spouse of an employee who becomes covered under the plan. The notice must be provided within the first 90 days of coverage under the group health plan. The general notice must include the following information:

  • The name of the plan and the name, address and telephone number of someone the employee and spouse can contact for more information on COBRA and the plan.
  • A general description of the continuation coverage provided under the plan.
  • An explanation of what qualified beneficiaries must do to notify the plan of qualifying events or disabilities.
  • An explanation of the importance of keeping the plan administrator informed of addresses of the participants and beneficiaries.
  • A statement that the general notice does not fully describe COBRA or the plan and that more complete information is available from the plan administrator and in the summary plan description (SPD).

The general notice requirement can be met by including the language in the plan’s SPD, as long as it is provided to both the employee and covered spouse. Alternatively, the regulations permit delivery of a single notice addressed to a covered employee and the covered employee’s spouse as long as they live at the same residence. If the employee and spouse live at separate addresses, then each must be sent a notice.

 

Election Notice

The election notice describes the rights to continuation coverage and explains how to make an election. The plan administrator must furnish an election notice to each qualified beneficiary–the covered employee, covered spouse, and any covered dependent child–who loses plan coverage in connection with the qualifying event. The election notice must be provided to the qualified beneficiaries within 14 days after the plan administrator receives the notice of a qualifying event.

 

The election notice should include the following information:

  • The name of the plan and the name, address and telephone number of the plan’s COBRA administrator.
  • Identification of the qualifying event.
  • Identification of the qualified beneficiaries (by name or by status).
  • An explanation of the qualified beneficiaries’ right to elect continuation coverage.
  • The date coverage will terminate (or has terminated) if continuation coverage is not elected.
  • How to elect continuation coverage.
  • What will happen if continuation coverage isn’t elected or is waived.
  • What continuation coverage is available, for how long and (if it is for less than 36 months) how it can be extended for disability or second qualifying events.
  • How continuation coverage might terminate early.
  • Premium payment requirements, including due dates and grace periods.
  • A statement of the importance of keeping the plan administrator informed of the addresses of qualified beneficiaries.
  • A statement that the election notice does not fully describe COBRA or the plan and that more information is available from the plan administrator and in the SPD.

 

Unavailability of Continuation of Coverage Notice

Individuals may provide notice of a qualifying event, a second qualifying event or a notice of disability, and it may be determined the individual is not entitled to continuation of coverage. If such an event occurs, the plan must give the individual a notice of unavailability of continuation coverage. The notice must explain the reason for denying the request. This notice must be provided within 14 days after the request is received.

 

Termination of Coverage Notice

If a participant’s coverage is terminated early, before the expiration of an applicable 18-, 29- or 36-month period upon the occurrence of certain specified events, the employer is required to provide a termination of coverage notice. The notice must include the date that coverage will terminate, the reason for termination and any rights the qualified beneficiary may have under the plan or applicable law to elect alternative group or individual coverage, such as a right to convert to an individual policy. While there is not a specific timeframe to provide such notice, the notice must be given as soon as practicable after the decision is made.

 

In summary, providing notices in compliance with the COBRA regulation is critical. In addition to providing the required content in the notices, documenting the method and timing of such delivery to the last known address is imperative in the event the employer is challenged in its obligation to provide such notices. Employers may review the disclosure rules at CFR 2520.104b-1(B) for guidance on the method of delivery and on furnishing notices to meet the required timing requirements under COBRA. Generally, the date of mailing or electronic transmission will be considered the date furnished when it comes to meeting the obligations regarding timing to provide the notices.

Model COBRA notices are provided on the U.S. Department of Labor’s COBRA Continuation webpage under the Regulations section. 

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